How are Crnas more cost effective?

[narcusprince]

Local group was told to higher more Crnas because they are more cost effective. I'm in the mil so I don't understand how they are more effective if the billing costs are not the same. The price of anesthesia is not fixed. Can someone help me with this argument?

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[caligas]

Local group was told to higher more Crnas because they are more cost effective. I'm in the mil so I don't understand how they are more effective if the billing costs are not the same. The price of anesthesia is not fixed. Can someone help me with this argument?

When someone says they are more cost effective it has nothing to do with billing. They are talking about the costs of labor. The argument is that 4 crnas plus one MD costs less in labor (salaries plus benefits) than the cost of 4 MDs needed to cover the same 4 rooms.

 

[Planktonmd]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

 

[urge]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

It is a little bit more complex than that if you consider that most CRNAs work only 3 12hr shifts a week. Plus overtime when they stay late. And calls.

 

[deleted171991]

It is a little bit more complex than that if you consider that most CRNAs work only 3 12hr shifts a week. Plus overtime when they stay late. And calls.

That will change, as their market gets flooded, too, with providers. They are just differently-shaped cogs.

 

[urge]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

Solution 1 is easily sustainable. Call every 4 days. MDs stay until the room finishes. Over 2 mo of vacation. Salary is too low IMHO.

Solution 2 is a bit of a headache. Call every day doing cases solo for the MD, working the next day, with 6 mo vacation. Or, call every other day with post call day off and no vacation. Or probably a mix of the above. Any permutation of the above still kind of sucks. CRNAs being shift workers will have a lot of down time if room finishes early, but will demand overtime for staying late. Best scenario is to hire them to do 5 8 hr shifts a week. That will come with a lot of overtime is the rooms don't finish before 3 pm every day. Your 200k in theoretical savings can be easily gone.

Solution 3 is just like 1, but I doubt they will do that schedule for 150k (and 50k in benefits). They will likely ask for almost double the usual salary. Supports that salary is too low for Solution 1.

 

[narcusprince]

I guess my question is if a MD does a case solo he bills more versus if the Crna does a case solo they bill less. Billing - labor costs= profit. So wouldn't the MD and Crna cost equal out?

 

[deleted162650]

I guess my question is if a MD does a case solo he bills more versus if the Crna does a case solo they bill less. Billing - labor costs= profit. So wouldn't the MD and Crna cost equal out?

No they bill exactly the same.

 

[Random Anesthesiologist]

No they bill exactly the same.

Except in critical access hospitals with Medicare.


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[urge]

Except in critical access hospitals with Medicare.


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In which case they bill even more than an MD.

The world is ass backwards.

 

[Random Anesthesiologist]

In which case they bill even more than an MD.

The world is ass backwards.

So, it's kind of a lie that they're more "cost effective", especially when it comes to procedures.


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[psychbender]

Well, depends on your perspective. To insurers and the public, they cost the same as we do. To employers (AMCs, hospitals, super partners), there can be a cost savings, if we both bill the same, and sign over our collections to our overlords in exchange for a salary.

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[Onefellswoop87]

So, it's kind of a lie that they're more "cost effective", especially when it comes to procedures.


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As I understand it, all mid levels are only cost effective from the institution's point of view. The insurance is billed the same. The patient is charged the same (or same copay if they see a PA/NP in clinic) but the institution saves money paying them less.

 

[Ezekiel2517]

You need to make them understand the difference between cost and cost effectiveness. A bottle of Precedex is significantly more costly than Haldol. But if the Precedex is able to more effectively treat a pt's delirium (which many studies have shown that it does) so that you can transfer the pt out of the ICU or discharge from the hospital more quickly, then it is significantly more cost effective to use Precedex rather than Haldol.
Since you were looking for an argument you can make: Even if it were less costly to use CRNA's (which is definitely debatable and in many cases just as costly), it would definitely be less cost effective since you would have to deal with the costs of inferior anesthestic care.

 

[Planktonmd]

As I understand it, all mid levels are only cost effective from the institution's point of view. The insurance is billed the same. The patient is charged the same (or same copay if they see a PA/NP in clinic) but the institution saves money paying them less.

Correct!

 

[skypilot]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

It is about the call schedule. If this is a surgi-center with set hours it is not an issue. In a surgi-center the salary for the MDs may be lower making the difference less. But in solution 2 and solution 3 you will have to pay the CRNAs overtime to take call and any cost savings will evaporate. Otherwise you have Q2 call for the docs in Solution 2 which is not sustainable. Solution 3 requires that you are in an opt-out state that does not require supervision and have CRNAs that are willing to take call without compensation (highly unlikely).

 

[Ignatius J]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

If you find cRNAs that will provide 24 hour call coverage 365 days a year along with liability coverage at that price, let me know. We can't even get 35-40 hour/week shift workers for that price.

 

[chocomorsel]

If you find cRNAs that will provide 24 hour call coverage 365 days a year along with liability coverage at that price, let me know. We can't even get 35-40 hour/week shift workers for that price.

You want to pay physicians that salary? Of course you won't find takers.

 

[urge]

You want to pay physicians that salary? Of course you won't find takers.

I believe he is talking about crnas.

 

[Mad Jack]

Let's say you want to staff a single location that has 4 ORs including covering people on vacation:
Solution 1: 5 MD's, MD only practice (4 doing cases and one on vacation) -----> total employment package: 400,000 x 5 = $2,000,000 / year
Solution 2: 2 MDs and 5 CRNAs care team model (provided 1 MD and 1 CRNA on vacation) -----> total package : (200,000 x 5) + (400,000 x 2) = $1,800,000 year
You could save $ 200,000 a year in theory compared to MD only practice
Solution 3: CRNA's solo practice ( 5 CRNAs covering same 4 rooms and one on vacation) ----> 200,000 x 5 = $1,000,000 / year
You can save $1000,000 / year compared to MD only practice

Given that the average anesthesiologist is putting in 60 hours per week, and the average CRNA is putting in 36-40, you're not getting the same level of coverage from 5 CRNAs versus 5 anesthesiologists. With one of each on vacation, you're getting 160 hours of CRNA coverage versus 240 hours of MD coverage- so you'd actually need 6 CRNAs, plus a seventh that's on vacation, to do the jobs of five MDs with one on vacation. That comes to $1.4 million versus the $2 million MD package, which is still a savings, but not the 50% savings noted.

 

[chocomorsel]

I believe he is talking about crnas.

They don't have CRNAs where he works. Unless things are changing, which would not be surprising.

 

[Mman]

If you find cRNAs that will provide 24 hour call coverage 365 days a year along with liability coverage at that price, let me know. We can't even get 35-40 hour/week shift workers for that price.

Huh? We get 40 hours per week plus at home beeper call once a week for total package of well under 200K per year for a CRNA. They get OT when they go beyond 40 hours, but still not even close to 200K per. And we could fill 10 extra spots tomorrow if we needed them. The waiting list for a job is growing, not shrinking.

 

[skypilot]

Huh? We get 40 hours per week plus at home beeper call once a week for total package of well under 200K per year for a CRNA. They get OT when they go beyond 40 hours, but still not even close to 200K per. And we could fill 10 extra spots tomorrow if we needed them. The waiting list for a job is growing, not shrinking.

But you pay time and a half for overtime? So if the CRNAs were working 60 hours per week instead of 40, they would be taking home well over 200k? And you are not in an opt-out state so you have to provide a salary for a supervising physician as well?

 

[urge]

Huh? We get 40 hours per week plus at home beeper call once a week for total package of well under 200K per year for a CRNA. They get OT when they go beyond 40 hours, but still not even close to 200K per. And we could fill 10 extra spots tomorrow if we needed them. The waiting list for a job is growing, not shrinking.

Somehow I don't believe it.

 

[Consigliere]

Somehow I don't believe it.

Believe it. My practice is the same - $175k with at home pager call but obligated to come in for any laboring pts. As an employer, I can confirm that there are a plethora of CRNAs to fill jobs. I live in a not so desirable area and we are EASILY able to hire CRNAs.

 

[chocomorsel]

Somehow I don't believe it.

I believe it.

 

[urge]

Believe it. My practice is the same - $175k with at home pager call but obligated to come in for any laboring pts. As an employer, I can confirm that there are a plethora of CRNAs to fill jobs. I live in a not so desirable area and we are EASILY able to hire CRNAs.

170k with w2 benefits. Well over 200k.

New grad salary is pretty much 150k. Add about 20 k for health care insurance, 6 k for FICA, 10k for malpractice, 10k for retirement, and 5 k for perks.

 

[Consigliere]

170k with w2 benefits. Well over 200k.

New grad salary is pretty much 150k. Add about 20 k for health care insurance, 6 k for FICA, 10k for malpractice, 10k for retirement, and 5 k for perks.

Do you have your own group? Do you regularly sign someone's paycheck? Then you don't know what you're talking about. The CRNA's total package may be CLOSE to $200k, but let me assure you, it is NOT "well over $200k" like you keep idiotically asserting. FYI, to me, "well over $200k" is in the $275k range.

 

[urge]

Do you have your own group? Do you regularly sign someone's paycheck? Then you don't know what you're talking about. The CRNA's total package may be CLOSE to $200k, but let me assure you, it is NOT "well over $200k" like you keep idiotically asserting. FYI, to me, "well over $200k" is in the $275k range.

Ten minutes ago you claimed your crnas as were not making 200k.

The problem is that you forgot to add all the benefits.

I bet they are in the 220s.

 

[Consigliere]

Ten minutes ago you claimed your crnas as were not making 200k.

The problem is that you forgot to add all the benefits.

I bet they are in the 220s.

I just posted their salary and not their total package.

 

[urge]

I just posted their salary and not their total package.

I know. Some of you cannot follow the discussion and then dare to argue with me when I set it back on track.

The whole thing is about total cost of a crna, not their salary.

 

[urge]

Huh? We get 40 hours per week plus at home beeper call once a week for total package of well under 200K per year for a CRNA.

FYI, to me, "well over $200k" is in the $275k range.

Right! When you read Mman's post you read he was paying 125k including benefits and you agreed with it?

 

[urge]

 

[Consigliere]

Right! When you read Mman's post you read he was paying 125k including benefits and you agreed with it?

Please show me where Mman said he was paying $125k including benefits. I can't seem to find that.

 

[urge]

Please show me where Mman said he was paying $125k including benefits. I can't seem to find that.

Well under 200k, which in you book must be 125k by your logic of well over 200 being around 275.

 

[Mman]

Somehow I don't believe it.

Our starting salary is 110K plus benefits which brings it up to 145K ish total package. When you add in senior people and the OT people work, the mean cost per CRNA for us is still under 200K total package. In other words, 100 CRNAs (and AAs) is a total cost to us of less than $20M. And our cost has been going down as the number of CRNAs looking for jobs has gone up.

 

[urge]

Our starting salary is 110K plus benefits which brings it up to 145K ish total package. When you add in senior people and the OT people work, the mean cost per CRNA for us is still under 200K total package. In other words, 100 CRNAs (and AAs) is a total cost to us of less than $20M. And our cost has been going down as the number of CRNAs looking for jobs has gone up.

Still don't believe it.

Show me an add where they offer 110k to a crna.

 

[Mman]

Still don't believe it.

Show me an add where they offer 110k to a crna.

we don't have to advertise, we have a waitlist

 

[urge]

we don't have to advertise, we have a waitlist

Sure. With that salary 6 standard deviations below the mean the wait list must be really long.

It's the guys paying 150 that need to advertise.

I get it.

 

[urge]

our cost has been going down as the number of CRNAs looking for jobs has gone up.

That I believe.

 

[Mad Jack]

Sure. With that salary 6 standard deviations below the mean the wait list must be really long.

It's the guys paying 150 that need to advertise.

I get it.

It's entirely possible in some markets. I lived in a pretty desirable market and the pay for a new CRNA was 150k/year to start four years back, but it's been so saturated that who knows what the offers are now. Granted, benefits were great, so they probably were looking at a 200k pay package at the end of the day, plus they got 107.50/hr for OT.

 

[Mman]

Sure. With that salary 6 standard deviations below the mean the wait list must be really long.

It's the guys paying 150 that need to advertise.

I get it.

we have more CRNA training programs within 200 miles of us than I care to count. We are swimming with new grads that want to stay in their geographic area.

 

[Planktonmd]

The bottom line: staffing with CRNA's does offer significant savings compared to physician only model and denying this fact is not going to make it go away!
In addition to the financial savings, CRNAs are nurses, and nurses are way more liked by hospital administrators than us greedy physicians.

 

[aneftp]

The AANA got one more trick up their sleaves.

Even if MDs take lesser pay and end up paid the same as CRNA.

The AANA will still pull the we are cheaper card. They will say MDs cost more to train!

Just imagine the public reaction. This time. If income is the same. The ASA better call out the AANA. And use reverse psychology. And tell the public that the AANA wants a less educated person taking care of loved ones even if both make the same money. The AANA would run out of bullets to shoot at that point.

 

[Planktonmd]

The AANA got one more trick up their sleaves.

Even if MDs take lesser pay and end up paid the same as CRNA.

The AANA will still pull the we are cheaper card. They will say MDs cost more to train!

Just imagine the public reaction. This time. If income is the same. The ASA better call out the AANA. And use reverse psychology. And tell the public that the AANA wants a less educated person taking care of loved ones even if both make the same money. The AANA would run out of bullets to shoot at that point.

If that day comes and MDs are paid the same as CRNAs, the AANA will claim that they are nurses by training, and as a result they care about the patients more than we do, so they are better! They actually already advertise themselves as being more passionate.

 

[deleted171991]

If that day comes and MDs are paid the same as CRNAs, the AANA will claim that they are nurses by training, and as a result they care about the patients more than we do, so they are better! They actually already advertise themselves as being more passionate.

The closer the end of the shift, the more passionately they watch the clock, not the patient.

I see it all the time in the ICU: if a patient develops a problem around shift change, he'd better not need treatment in the following 2 hours.

 

[Mman]

The AANA got one more trick up their sleaves.

Even if MDs take lesser pay and end up paid the same as CRNA.

The AANA will still pull the we are cheaper card. They will say MDs cost more to train!

But yet it is still more costly to the system to have a CRNA in a room than a resident.

 

[IlDestriero]

The closer the end of the shift, the more passionately they watch the clock, not the patient.

I see it all the time in the ICU: if a patient develops a problem around shift change, he'd better not need treatment in the following 2 hours.

I've seen that too many times with transfers to the OR, etc. on call, usually a call from me or the impatient surgeon to the nurse manager reminding them that the OR and its complement of staff doesn't wait for shift change and if it was elective surgery it wouldn't be done at 7pm, etc. clears it up. Generally I am the good cop and the surgeon is the bad cop. Lol.
I ran into an impending crisis at shift change as a resident in the ICU and it was one of the few times I've had to unload both barrels and reload to unload on the obstructionist nurse manager as well. I fully expected to be in the PDs office the next AM, but as I wasn't, I suspect that they woke up to the gravity of the situation and their part in not stepping up to the plate to help provide their "critical" nursing care.


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Il Destriero

 

[IM311]

I've seen that too many times with transfers to the OR, etc. on call, usually a call from me or the impatient surgeon to the nurse manager reminding them that the OR and its complement of staff doesn't wait for shift change and if it was elective surgery it wouldn't be done at 7pm, etc. clears it up. Generally I am the good cop and the surgeon is the bad cop. Lol.
I ran into an impending crisis at shift change as a resident in the ICU and it was one of the few times I've had to unload both barrels and reload to unload on the obstructionist nurse manager as well. I fully expected to be in the PDs office the next AM, but as I wasn't, I suspect that they woke up to the gravity of the situation and their part in not stepping up to the plate to help provide their "critical" nursing care.


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Il Destriero

 

[IM311]

Local group was told to higher more Crnas because they are more cost effective. I'm in the mil so I don't understand how they are more effective if the billing costs are not the same. The price of anesthesia is not fixed. Can someone help me with this argument?

Because anesthesiologists hijack their (profession) in order to "employ" crnas doing the actual anesthesia getting paid 1/4-1/3 the pay. The farce is that crnas are cheaper, indeed the reimbursement is mostly the same. The way that crnas are more cost effective is that they take the same or slightly more pay without the stipends that their physician counterparts demand for call etc. Whereas the stipends can be =>7 figures.

My 9 colleagues and I make a great salary and provide every kind of regional anesthesia service. Our administration is adamantly apposed to bringing in even one anesthesiologist. Just too expensive and ZERO added value. If there is someone that thinks they can add to our practice,md or crna, I will give you administration's contact info.